1. End of Life Decisions by Adults with Cancer : Role of Religious Practices and Spiritual Beliefs Rudolph M. Navari, M.D., Ph.D. Assistant Dean and Director Indiana University School of Medicine Director, Notre Dame Cancer Institute

2. End of Life Decisions Do cancer patients receiving treatment have an advance directive? What are the influencing factors on end of life decisions? What is role of religious practices or spiritual beliefs?

3. End of Life Decisions Two community oncology practices Patient interview during an office visit Interviewer unknown to patient Family member or significant other may be present Interview instrument: 30 questions, 20 -30 minutes

4. End of Life Decisions Interview Specific and open ended questions Advance directive? Influences on end of life decisions? Religious/Spiritual affiliations/practices? Family discussions? Physician discussions?

5. End of Life Decisions Patient Characteristics - 353 consecutive patients - 339 completed interview - Advanced cancer receiving active treatment (chemotherapy, radiation, hormonal therapy) - Common cancers (lung, breast, prostate, colon)

6. End of Life Decisions Patient characteristics - Age (mean): 66.2 yrs - Gender:52.7% female - Marital Status: Married:57% Single:18% Separated, Divorced, Widowed: 25%

7. End of Life Decisions Patient characteristics (No. Patients, %) - Race: Caucasian: 197 (58%) African-American: 104 (30%) Hispanic: 38 (11%) - Education: High School: 206 (61%) College: 61 (18%)

8. End of Life Decisions Religious / Spiritual Affiliation - Christian:210 (61.9%) - Muslin: 23 ( 6.7%) - Jewish: 20 ( 5.9%) - Other: 24 ( 7.1%) - None: 62 (18.3%)

9. End of Life Decisions Religious / Spiritual Practices - Group Activity Weekly: 203 (59.8%) - Individual Activity Weekly:156 (46.0%) - Prayed Daily: 51 (15.1%)

10. End of Life Decisions Advance Directive - Total:173 (51.0%) Living Will:156 (46.0%) DPA: 17 ( 5.0%)

11. End of Life Decisions Major Influences - Family Discussions: 214 (63%) - Quality of Life: 190 (56%) - Personal Experiences: 170 (50%) - Religious/Spiritual Beliefs: 163 (48%) - Financial Burdens: 140 (41%) - Physician Discussions: 135 (39%) - Individuals: 33 (10%)

12. End of Life Decisions Factors Associated with Advance Directives - Specific Religious Affiliation - Participated in daily or weekly religious / spiritual practices - Family discussions - Physician discussions

13. End of Life Decisions Conclusions In a patient population with potentially life threatening disease, religious and spiritual affiliations and practices, as well as discussions with family and physicians, appear to significantly influence end of life decisions.